OCR Text |
Show TO FIND THE WOUNDED ARTERY BY DISSECTION. ;358 255 01" I'Ell.‘ SEAT OF THE VITAL PARTS IN Till-l CHEST. rib, the thrust made will pierce the lungs and mediastinum, and pass through the right auricle. A thrust perpendicularly down. by the left side of the sternum, betwixt the fourth and fifth ribs, will pass through the upper part of the heart, near the root of the pulmonary artery. may pass through the chest and lie among the muscles of the back; or it may pass out altogether. When the ball enters the chest the shot-hole is evident to the finger or the probe, and the air is thrown out from the wound in expiration. When it has pierced the lungs frothy blood is spit up ; but the question whether the ball is lodged in the chest, or has passed into the axilla, shoulder, or under the scapula, will A thrust perpendicularly to the convexity of the chest, immediately under the right pap, and of course the fifth rib, will pass through the root of the lungs among the great. vessels. A thrust with the small sword, horizontally from the great est lateral conveirlty and upper edge of the seventh rib, w ill pass through the middle of the lower portion of the posterior lobe of the right lung, behind the heart, into the posterior med‘iastinum, where the aorta and oesophagus are about to pass through the diaphragm. The arch of the aorta lies three-fourths of an inch below the level of the upper part of the sternum. If the assassin strikes within the clavicle, obliquely down. with the stiletto, the point will, at the depth of three quarters of an inch below the upper edge of the sternum, pass into the arch of the aorta, and occasion a more sudds' n death than if struck into the heartas ; if the aorta should escape, seine of the great branches will be wounded; even if the great branches should escape, and the trachea be wounded, the patient is in danger of instantaneous death, from the blood passing into the trachea suffocating him. In regard to the course of balls through the chest, we are apt to be much deceived. The ball will strike the sternum r.~«*~?ouxWJa-,.N,.-.u ‘_,. or cartilagcs of the rib, and then glide betwixt. the skin and the ribs, and either pass out altogether at the opposite point in the back, or he there under the skin. A ball may pcne~ trate the chest and be there; it may pierce the lungs; it * I have a very interesting letter from Mr. Fuge, surgeon of the Dorset regiment, giving me an account of the case eta soldier, who was wounded at Corunna, and who lived fourteen days after a ball bud pierced the right ventricle of the heart. The ball had entered on the left side of the sternum, betwixt. the cartilages of the second and third ribs. not be so easily determined. When the lungs are wounded, at first there is blood spit up ; but that may cease from the vessels of the lungs closing, and from the diminished strength of the patient, the cough being dry and weak. \thn with the weakness and deadly aspect, coder-coloured discharge is poured out from the wound, it is an exceeding bad sign -, it proceeds from the res solution of the cxtravasated blood. TO CUT FOR THE CARO‘IID Alll‘L‘l'tY. iii -- * wom M09817 To cut down for the trunk of the carotid artery, I would turn the chin towards the same side, and then make an inci~ sion three inches in length along the anterior edge of the sterno mastoideus muscle. In doing this, the firm cellular membrane, and some of the anterior tibres of the platysma myoides must be cut. Having fairly laid bare the edge of the mastoideus, we ought to do no more with the edge of the knife; we ought then to hold aside the mastoideus, and, with the fingers and handle of the knife, dig down to the artery, and free it from the vein and par vagum, as we should free the vas deferens from the rest of the sperinatic cord. We find a small muscle, the omo-hyoideus passing obliquely over the artery, about an inch and a half from the head of the clavicle. The great internal jugular vein is close on the outside of the artery, the par vagum betwixt the vessels, the sympathetic nerve below, and close upon the vertebra. If a small nerve be observed running above the artery, it is the descendens noni. |